Thirty women had taken refuge in a maternity hospital in El Fasher, Sudan, as the slaughter began. Among them were new mothers, while others were actively in labor.
On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “The sounds of screaming reached me of women and children,” he recounts. “A massacre was taking place inside the hospital. Survival meant running for your life.”
This brutal attack stands as a particularly egregious examples in the two-year civil war tearing the North African nation apart. Armed soldiers stormed the facility, allegedly slaughtering more than 460 patients and their companions.
Rights organizations have labeled it “a crime beyond words,” and a prime example of the deteriorating protection for civilians caught in conflict zones in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
A Record of Violence Against Maternal Care
While all major powers have signed the international laws of war, which obligate them to protect civilians, the past year has seen a record number of assaults against medical infrastructure. Mothers in labor are highly exposed due to their reliance on locally available medical care.
An investigation of records show an unprecedented scale of attacks: nearly 300 violent acts against maternity care facilities, staff, and pregnant women over the last three years, including at least 119 bombardments of hospitals and delivery wards.
“This is not natural consequences of war. They form a pattern of reproductive violence.”
The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where countless of women bearing children are confined.
Deaths have occurred, blocked from reaching help, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been killed, 15 kidnapped, and 101 arrested—sometimes in the act of delivering babies.
A Worldwide Emergency in Maternal Health
The numbers are probably a substantial underreporting, as they are limited to incidents covered by the media. In many conflict zones, communications are sparse.
Last year, analysis showed that 50% of women who perished while pregnant or giving birth were in a conflict area. This underscores a horrifying trend.
Apart from fatalities, these attacks are destroying maternal and neonatal care facilities, jeopardizing the future to demographic stability.
Conditions within Gaza
In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as part of the basis for genocide allegations.
Despite periods of calm, doctors report that women and children are still perishing from medical shortages, owing to desperate lacks of medicine and equipment. Accounts describe women having children by the roadside because hospitals were out of reach.
“We’ve had rockets fired at the wards, operating rooms, and maternity wards,” states the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or aiming to influence birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 maternity and neonatal facilities have been damaged or destroyed in Ukraine. Accounts from embattled medical centers describe births occurring in shelters and extreme psychological pressure leading to maternal health issues.
“Russia is targeting us deliberately,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“The truth of the matter is, every facility is now a potential target,” comments a medical director in Sumy. “If a drone is destroyed, the falling debris could impact a hospital.”
Accountability Evaporates
For the hundreds of millions of women living close to deadly warfare, there are scarce guarantees and rare trials for atrocities for those assaulting reproductive health.
This lack of accountability has fostered a “culture of impunity,” says a human rights lawyer. “Attacks on reproductive healthcare, like coerced birth or involuntary sterilization, may constitute acts of genocide by preventing births.”
Additional Hotspots
In El Fasher, the area lacked access to humanitarian aid long before the hospital attack, with malnutrition increasing drastically, especially among children and pregnant women.
In the Democratic Republic of the Congo, information is restricted due to a communication blackout from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, killing mothers, babies, and nurses.
In Myanmar, clinics have been attacked and dozens of midwives and patients have been arrested, killed, or injured over the past two years of civil war.
The Collapse of Safe Childbirth
A large proportion of mother deaths are averted with basic healthcare, but war collapses medical infrastructure. Rights groups note that terror is compelling women away from facilities once considered safe, pushing them toward risky home births devoid of emergency care.
“If maternity hospitals are being deliberately targeted indicates a wider and more disturbing trend: the use of violence against hospitals as a tool for terror and to break societal cohesion,” observes a legal researcher.
“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘harmful to the enemy’, which has often been cited as an excuse.”
